Pulpotomy in mature permanent teeth - Part II
There are three techniques available for treatment of immature permanent teeth with exposed vital pulps: direct pulp capping, partial pulpotomy and complete pulpotomy.
Indication for permanent tooth pulpotomy :
- Tooth has no history of spontaneous pain
- Tooth has no discomfort to percussion, no vestibular swelling and no mobility
- Radiographic examination shows normal appearance of periodontal attachment
- Pulp is exposed during caries removal or subsequent to recent trauma
- Tissue appears vital
- Bleeding from the pulp exposure, stops with isotonic saline irrigation within 3minutes.
Age : Female 17 years old
Tooth : Second mandibular right molar
Dg : Deep caries with pulp penetrating
Treatment plan : Pulpotomy
Isolation, initial preparation which has resulted in pulp opening.
Caries removal prior to pulpal access is required to reduce the bacterial load.
Haemostasis – cotton pellet within 3min.
MTA (mineral trioxide aggregate) was placed against the wound.
X-ray after 1.5 year
The patien has no complaints
The vitality test – positive delayed
Pulpotomy is a prospective substitute for root canal treatment in managing permanent teeth with carious pulp exposures, even in permanent teeth with irreversible pulpitis.
Large, well-designed trials comparing pulpotomy with other treatments in terms of cost-effectiveness should be informative.
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5. Linsuwanont P, Wimonsutthikul K, Pothimoke U, Santiwong B. Treatment outcomes of mineral trioxide aggregate pulpotomy in vital permanent teeth with carious pulp exposure: The retrospective study. J Endod. 2017;43:225–30.
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